Healthcare Provider Details

I. General information

NPI: 1255797585
Provider Name (Legal Business Name): DOLLISON CHIROPRACTIC OFFICE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 9TH ST
CAMBRIDGE OH
43725-2854
US

IV. Provider business mailing address

500 S 9TH ST
CAMBRIDGE OH
43725-2854
US

V. Phone/Fax

Practice location:
  • Phone: 740-439-9393
  • Fax: 740-439-9395
Mailing address:
  • Phone: 740-439-9393
  • Fax: 740-439-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberOH1731
License Number StateOH

VIII. Authorized Official

Name: DR. CARL RICHARD DOLLISON
Title or Position: OWNER/CHIROPRACTOR
Credential: D.C.
Phone: 740-439-9393